A limited number of longitudinal studies have examined the symptoms associated with long-COVID-19. We conducted an assessment of symptom onset, severity and patient recovery, and determined the percentage of patients who experienced reinfection up to 2 years after the initial onset of the disease. Our cohort comprises 377 patients (≥18 years) with laboratory-confirmed COVID-19 in a secondary hospital (Madrid, Spain), throughout March 3–16, 2020. Disease outcomes and clinical data were followed-up until August 12, 2022. We reviewed the evolution of the 253 patients who had survived as of April 2020 (67.1%). Nine died between April 2020 and August 2022. A multivariate regression analysis performed to detect the risk factors associated with long-COVID-19 revealed that the increased likelihood was associated with chronic obstructive lung disease (OR 14.35, 95% CI 1.89–109.09; p = 0.010), dyspnea (5.02, 1.02–24.75; p = 0.048), higher LDH (3.23, 1.34–7.52; p = 0.006), and lower D-dimer levels (0.164, 0.04–0.678; p = 0.012). Reinfected patients (n = 45) (47.8 years; 39.7–67.2) were younger than non-reinfected patients (64.1 years; 48.6–74.4)) (p < 0.001). Patients who received a combination of vaccines exhibited fewer symptoms (44.4%) compared to those who received a single type of vaccine (77.8%) (p = 0.048). Long-COVID-19 was detected in 27.05% (66/244) of patients. The early detection of risk factors helps predict the clinical course of patients with COVID-19. Middle-aged adults could be susceptible to reinfection, highlighting the importance of prevention and control measures regardless of vaccination status.

Objectives: Serologic techniques can serve as a complement to diagnose SARS-CoV-2 infection. The objective of our study was to compare the diagnostic performance of six immunoassays to detect antibodies against SARS-CoV-2: three lateral flow immunoassays (LFAs), one ELISA and two chemiluminescence assays (CLIAs). Methods: We evaluated three LFAs (Alltest One Step and SeroFlash), one ELISA (Dia.Pro) and two CLIAs (Elecsys and COV2T). To assess the specificity, 60 pre-pandemic sera were used. To evaluate the sensitivity, we used 80 serum samples from patients with positive PCR for SARS-CoV-2. Agreement between techniques was evaluated using the kappa score (k). Results: All immunoassays showed a specificity of 100 % except for SeroFlash (96.7 %). Overall sensitivity was 61.3 %, 73.8 %, 67.5 %, 85.9 %, 88.0 % and 92.0 % for Alltest, One Step, SeroFlash, Dia.Pro, Elecsys and COV2T, respectively. Sensitivity increased throughout the first two weeks from the onset of symptoms, reaching sensitivities over 85 % from 14 days for all LFAs, being One Step the most sensitive (97.6 %), followed by SeroFlash (95.1 %). Dia.Pro, Elecsys and COV2T showed sensitivities over 97 % from 14 days, being 100 % for COV2T. One Step showed the best agreement results among LFAs, showing excellent agreement with Dia.Pro (agreement = 94.2 %, k = 0.884), COV2T (99.1 %, k = 0.981) and Elecsys (97.3 %, k = 0.943). Dia.Pro, COV2T and Elecsys also showed excellent agreement between them. Conclusions: One Step, Dia.Pro, Elecsys and COV2T obtained the best diagnostic performance results. All these techniques showed a specificity of 100 % and sensitivities over 97 % from 14 days after the onset of symptoms, as well as excellent levels of agreement.

AbstractBACKGROUNDThe coronavius disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reached Spain by 31 January 2020, in April 2020, the Comunidad de Madrid suffered one of the world’s highest crude mortality rate ratios. This study aimed to detect risk factors for mortality in patients with COVID-19.METHODSOur cohort were all consecutive adult patients (≥18 years) with laboratory-confirmed COVID-19 at a secondary hospital in Madrid, March 3-16, 2020. Clinical and laboratory data came from electronic clinical records and were compared between survivors and non-survivors, with outcomes followed up until April 4. Univariable and multivariable logistic regression methods allowed us to explore risk factors associated with in-hospital death.FINDINGSThe cohort comprised 562 patients with COVID-19. Clinical records were available for evaluation for 392 patients attended at the emergency department of our hospital, of whom 199 were discharged, 85 remained hospitalized and 108 died during hospitalization. Among 311 of the hospitalized patients, 34.7% died. Of the 392 patients with records, the median age was 71.5 years (50.6-80.7); 52.6% were men. 252 (64.3%) patients had a comorbidity, hypertension being the most common: 175 (44.6%), followed by other cardiovascular disease: 102 (26.0%) and diabetes: 97 (24.7%). Multivariable regression showed increasing odds of in-hospital death associated with age over 65 (odds ratio 8.32, 95% CI 3.01–22.96; p<0.001), coronary heart disease (2.76, 1.44-5.30; 0.002), and both lower lymphocyte count (0.34, 0.17–0.68; 0.002) and higher LDH (1.25, 1.05-1.50; 0.012) per 1-unit increase and per 100 units respectively.INTERPRETATIONCOVID-19 was associated in our hospital at the peak of the pandemic with a crude mortality ratio of 19.2% and a mortality ratio of 34.7% in admitted patients, considerably above most of the ratios described in the Chinese series. These results leave open the question as to which factors, epidemiological or intrinsically viral, apart from age and comorbidities, can explain this difference in excess mortality.FUNDINGNone.

La citometría de flujo ha mostrado en los últimos años su utilidad en el cribado de infección urinaria y su integración en los Servicios de Microbiología podría evitar la siembra de hasta el 60% de las muestras del área. El propósito de este trabajo es valorar su utilidad en el cribado universal y la rentabilidad diagnóstica en diferentes subpoblaciones. Se analizaron 1.338 muestras mediante citometría de flujo (Sysmex UF-1000i) y urocultivo en agar CPS. Se informaron como positivos los cultivos con 1 o 2 uropatógenos y recuentos superiores a 105 UFC/ml y en poblaciones especiales, recuentos inferiores con un solo uropatógeno. Utilizando un punto de corte de > 17,1 bacterias/μl o > 29,5 leucocitos/μl se consiguió una sensibilidad del 95,15% y un porcentaje de cribado del 32,14%. De los once falsos negativos, seis presentaban recuentos bajos y en uno se cultivó Candida glabrata. En el estudio por subgrupos se encontraron variaciones estadísticamente significativas respecto al género y la procedencia. El punto de corte en los varones fue inferior con respecto a las mujeres. Sin embargo, se mantuvo estable en las muestras de Atención Primaria, reduciéndose sustancialmente en las hospitalarias. El valor predictivo negativo permaneció siempre por encima del 95%. El sistema de citometría de flujo puede evitar la siembra del 32% de las muestras aplicando criterios estrictos de positividad. En nuestro hospital, habría evitado la siembra de 13.705 orinas en 2016, y podría aumentar combinando los puntos de corte con la procedencia y el género de las muestras. Flow cytometry has shown to be useful for ruling out urinary tract infection over the last few years. Its integration into the Microbiology Laboratories could avoid the urine culture of 60% of the samples. The aim of this study is to evaluate the usefulness of flow cytometry in the universal screening, as well as to improve its efficacy by using specific cut-off points in different groups. A total of 1338 urine samples were analysed by flow cytometry (Sysmex UF-1000i), as well as a urine culture in CPS agar. Cultures with one or two pathogens and more than 10,000 CFU/ml, and special cases with less counts but just one pathogen, were considered as positive. A cut-off of > 17.1 bacteria/μl or > 29.5 leucocytes/μl resulted with a sensitivity of 95.15% and a screening yield of 32.14%. Eleven false negative were obtained, but six of them showed low counts, and another was due to Candida glabrata. On the other hand, statistically significant variations were found as regards gender and origin of the patients. The cut-off of male samples was lower than female ones. However, it remained stable in the samples from Primary Care, and it decreased notably in those from the hospital. The negative predictive value always remained over 95%. Automated flow cytometry can avoid the culture of 32% of samples, even after applying tight positive criteria. In the study hospital, it would have avoided the culture of 13,705 urine samples in the year 2016. These results could improve by combining cut-off points, gender, and origin of patients.

ABSTRACT The molecular epidemiology of HIV-1 is constantly changing, mainly as a result of human migratory flows and the high adaptive ability of the virus. In recent years, Spain has become one of Europe's main destinations for immigrants and one of the western European countries with the highest rates of HIV-positive patients. Using a phylogeographic approach, we have analyzed the relationship between HIV-1 variants detected in immigrant and native populations of the urban area of Madrid. Our project was based on two coincidental facts. First, resistance tests were extended to naïve and newly diagnosed patients, and second, the Spanish government legislated the provision of legal status to many immigrants. This allowed us to obtain a large data set ( n = 2,792) from 11 Madrid hospitals of viral pol sequences from the two populations, and with this unique material, we explored the impact of immigration in the epidemiological trends of HIV-1 variants circulating in the largest Spanish city. The prevalence of infections by non-B HIV-1 variants in the studied cohort was 9%, rising to 25% among native Spanish patients. Multiple transmission events involving different lineages and subsubtypes were observed in all the subtypes and recombinant forms studied. Our results also revealed strong social clustering among the most recent immigrant groups, such as Russians and Romanians, but not in those groups who have lived in Madrid for many years. Additionally, we document for the first time the presence of CRF47_BF and CRF38_BF in Europe, and a new BG recombinant form found in Spaniards and Africans is tentatively proposed. These results suggest that the HIV-1 epidemic will evolve toward a more complex epidemiological landscape.